The development and implementation of resuscitation systems of care is founded on the Utstein Formula for Survival.1 The Utstein Formula holds that resuscitation survival is based on synergy achieved by the development and dissemination of medical science (ie, resuscitation guidelines based on the best available evidence); educational efficiency, which includes the effective training of resuscitation providers and members of the general public; and local implementation, which includes seamless collaboration between caregivers involved in all stages of resuscitation and postcardiac arrest care (Figure 1). Post-event debriefing is defined as a discussion between 2 or more individuals in which aspects of performance are analyzed,6 with the goal of improving future clinical practice.7 During debriefing, resuscitation team members may discuss process and quality of care (eg, algorithm adherence), review quantitative data collected during the event (eg, CPR metrics), reflect on teamwork and leadership issues, and address emotional responses to the event.813 A facilitator, typically a healthcare professional, leads a discussion focused on identifying opportunities and strategies for improving performance.8,9,11,13,14 Debriefings may occur either immediately after a resuscitation event (hot debriefing) or at a later time (cold debriefing).7,9,15 Some debriefings take the form of personalized reflective feedback conversations,1,4 while others involve group discussion among a larger, multidisciplinary resuscitation team.2,3 We examined the impact of postevent clinical debriefing on process measures (eg, CPR quality) and patient outcomes (eg, survival). Which drug should be given next? It is reasonable for organizations that treat cardiac arrest patients to collect processes-of-care data and outcomes. Another example beyond that of our own bodies would be to visualize a spider web. 1-800-242-8721 The system Provides the links for the Chain of Survival Determines the strength of each link and of the chain Determines the ultimate outcome Provides collective support and organization Healthcare delivery requires structure (eg, people, equipment, education) and processes (eg, policies, protocols, procedures) that when integrated 5. Decreased cardiac output What is the recommended next step after a defibrillation attempt? We recommend that emergency dispatch centers offer CPR instructions and empower dispatchers to provide such instructions for adult patients in cardiac arrest. Organ donation in any setting raises important ethical issues. Get your ACLS certificate online today with our . In response to data showing low bystander CPR rates in some neighborhoods, free CPR classes were provided in community centers in those neighborhoods. When a caller describes an adult victim as unresponsive, with absent or abnormal breathing, telecommunicators should conclude that the victim is experiencing OHCA and should immediately provide T-CPR instructions. Many industries, including healthcare, collect and assess performance data to measure quality and identify opportunities for improvement. We considered cognitive aids as a presentation of prompts aimed to encourage recall of information in order to increase the likelihood of desired behaviors, decisions, and outcomes.12 Examples include checklists, alarms, mobile applications, and mnemonics. No RCTs were identified on the use of early warning scoring systems with the specific goal of decreasing adult IHCA. There are no obvious signs of heart failure. Recovery is a critical component of the resuscitation Chain of Survival. A growing number of CACs also have the capability to provide extracorporeal membrane oxygenation and/or other forms of circulatory support. The Systems of Care Writing Group included a diverse group of experts with backgrounds in clinical medicine, education, research, and public health. Lesson 9: Stroke Part 2.Why is it important for EMS personnel to alert the receiving facility stroke team as soon as possible? Lesson 8: Acute Coronary Syndromes Part 1. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. 2020;142(suppl 2):S580S604. One prospective, observational study of post- OHCA debriefing among prehospital personnel demonstrated improved quality of resuscitation (ie, increased chest compression fraction, reduced pause duration) but no improvement in survival to discharge. Readers are directed to the AHA CPR and ECC website (cpr.heart.org) for the most recent guidance.1. Cardiac arrest centers (CACs), although still lacking official criteria for designation as has been established for other centers of expertise, are specialized facilities that provide comprehensive, evidence-based postcardiac arrest care, including emergent cardiac catheterization, targeted temperature management, hemodynamic support, and neurological expertise. Donation after circulatory death may occur in controlled and uncontrolled settings. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Each recommendation was developed and formally approved by the writing group from which it originated. Patients who do not have ROSC after resuscitation efforts and who would otherwise have termination of resuscitative efforts may be considered candidates for donation in settings where such programs exist. We recommend that public access defibrillation programs for patients with OHCA be implemented in communities at risk for cardiac arrest. In response to data showing that many newly born infants became hypothermic during resuscitation, a predelivery checklist was introduced to ensure that steps were carried out to prevent this complication. What is the primary time window for the administration of fibrinolytic therapy, timed from the onset of systems? The AHAs ACLS course builds on the foundation of lifesaving BLS skills, emphasizing the importance of continuous, high-quality CPR. Each of these resulted in a description of the literature that facilitated guideline development. The T-CPR process should be scripted to maximize the number of OHCA victims receiving bystander CPR, and quality improvement mechanisms should be used routinely. Important considerations in this decision- making process must include transport time, the stability of the patient, and the ability of the transporting service to provide needed care. We recommend that emergency dispatch centers offer CPR instructions and empower dispatchers to provide such instructions for adult patients in cardiac arrest. Within the hospital, the work of physicians, nurses, respiratory therapists, pharmacists, and many other professionals supports resuscitation outcomes. For each recommendation in Part 7: Systems of Care, the originating writing group discussed and approved specific recommendation wording and the COR and LOE assignments. Ventricular fibrillation has been refractory to a second shock. Lesson 7: Recognition: Signs of Clinical Deterioration. Some treatment recommendations involve medical care and decision-making after return of spontaneous circulation (ROSC) or after resuscitation has been unsuccessful. This ACLS/PALS course provides updated information on protocols and advances in emergency response techniques while meeting your recertification needs. AEDs are safe for use with children. Thus, everyone must strive to make sure each link is strong. We recommend that all patients who are resuscitated from cardiac arrest but who subsequently progress to death be evaluated for organ donation. Efforts to support the ability and willingness of members of the general public to perform cardiopulmonary resuscitation (CPR), and to use an automated external defibrillator, improve resuscitation outcomes in communities. Our hands-on course is specifically designed for dental offices. Lesson 8: Acute Coronary Syndromes Part 1. pg.29. Lesson 5: High Quality BLS Part 1.Which component of high-quality CPR directly affects chest compression fraction? In Part 7: Systems of Care, we explore resuscitation topics that are common to the resuscitation of infants, children, and adults. Evaluate the following statements regarding seeds. Oxygen (if needed), aspirin, nitroglycerin, morphine (if needed). Advanced resuscitation interventions, including pharmacotherapy, advanced airway interventions (endotracheal intubation or supraglottic airway placement), and extracorporeal CPR may also improve outcomes in specific resuscitation situations. pgs27-28.What are the 3 signs of clinical deterioration that would cause activation of a rapid response system? Recommendation-specific text clarifies the rationale and key study data supporting the recommendations. A regionalized approach to postcardiac arrest care that includes transport of acutely resuscitated patients directly to specialized cardiac arrest centers is reasonable when comprehensive postarrest care is not available at local facilities. Lesson 8: Acute Coronary Syndromes Part 2. Lesson 9: Stroke Part 2.What stroke screen was used in the stroke video? Signs of shock It is reasonable for debriefings to be facilitated by healthcare professionals familiar with established debriefing processes. In the hospital setting, preparedness includes early recognition of and response to the patient who may need resuscitation (including preparation for high-risk deliveries), rapid response teams (see Prevention of IHCA), and training of individuals and resuscitation teams. Prior to appointment, writing group members disclosed all commercial relationships and other potential (including intellectual) conflicts. Lesson1: system of care.Which one of the following is an interdependent component of systems of care? Lesson 13: Post-Cardiac Arrest Care. Dealroom202239.pdf. [15] A quality healthcare system is coproduced by patients, families and healthcare professionals working interdependently to cocreate and codeliver care. Because provider recall of events and self-assessment of performance are often poor. Care (Updated May 2019)*, CPR & First Aid in Youth Sports Training Kit, Resuscitation Quality Improvement Program (RQI), Coronavirus Resources for CPR & Resuscitation, Advanced Cardiovascular Life Support (ACLS), Resuscitation Quality Improvement Program (RQI), COVID-19 Resources for CPR & Resuscitation, Claiming Your AHA Continuing Education Credits, International Liaison Committee on Resuscitation. This Part focuses on recommendations for broad interventions along the entire Chain of Survival that can improve outcomes for all rather than for merely one patient. 1-800-242-8721 In other words, there is a ripple of movement . Although the concept is logical, cognitive aids (other than T-CPR) to assist bystanders in performing CPR have not yet proven effective. An educational system that fosters shared learning across multiple professions, in settings that include but transcend hospitals, can create an interdependent workforce able to foster community health and tackle complex problems such as health inequities, unsustainable waste of resources, and fragmentation of care that leads to great cost and . These procedures are described more fully in Part 2: Evidence Evaluation and Guidelines Development.2 Disclosure information for writing group members is listed in Appendix 1. Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Outside the hospital, immediate next steps include phoning the universal emergency response number (eg, 9-1-1) and sending someone to get the nearest AED. Performance-focused debriefing of rescuers after cardiac arrest can be effective for out-of-hospital systems of care. These recommendations were created by the AHA Adult Basic and Advanced Life Support Writing Group and are supported by a 2020 ILCOR systematic review.33, Despite the recognized role of lay first responders in improving OHCA outcomes, most communities experience low rates of bystander CPR8 and AED use.1 Mobile phone technology, such as text messages and smartphone applications, is increasingly being used to summon bystander assistance to OHCA events. A growing and important body of research examines interventions to benefit the cardiac arrest survivor.10. Lesson 11: Tachycardia. Because the causes and treatment of cardiac arrest differ between adults and infants/children as well as between IHCA and OHCA, specific Chains of Survival have been created for different age groups and situations (Figure 2). Lesson 9: Stroke Part 1. In determining the COR, the writing group considered the LOE and other factors, including systems issues, economic factors, and ethical factors such as equity, acceptability, and feasibility. A telecommunicator receiving an emergency call for service (ie, a 9-1-1 call) for an adult patient in suspected cardiac arrest first should acquire the location of the emergency so that appropriate emergency medical response can be dispatched simultaneous to OHCA identification. Lesson 5: High Quality BLS Part 1.Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? These recommendations were created by the AHA Adult Basic and Advanced Life Support Writing Group and are supported by the 2019 AHA Focused Update on Systems of Care: Dispatcher-Assisted CPR and Cardiac Arrest Centers: An Update to the AHA Guidelines for CPR and ECC, a 2018 ILCOR systematic review, and a 2020 AHA statement.3,5,6, These recommendations were created by the AHA Adult Basic and Advanced Life Support Writing Group and are supported by the 2019 AHA Focused Update on Systems of Care: Dispatcher-Assisted CPR and Cardiac Arrest Centers: An Update to the AHA Guidelines for CPR and ECC; a 2018 ILCOR systematic review; and a 2020 AHA statement.3,5,6, These recommendations were created by the AHA Pediatric Basic and Advanced Life Support Writing Group and are supported by the 2019 AHA Focused Update on Pediatric Basic Life Support: An Update to the AHA Guidelines for CPR and ECC and a 2019 ILCOR systematic review.6. The system provides the links for the chain and determines the strength of each link and the chain as a whole. Fast and deep compressions, 100 compressions per minute Two inches deep, complete rebound If you can provide breaths, 2 breaths for 30 comps If you cannot provide breaths, just give chest comps The provider who retrieved the AED applies the AED and follows directions given by the device. Based on meta-analysis of the 2 largest randomized trials comparing dispatcher compression-only CPR with conventional CPR (total n=2496), dispatcher instruction in compression-only CPR was associated with long-term survival benefit compared with instruction in chest compressions and rescue breathing. Specific recommendations for targeted temperature management are found in Parts 3, 4, and 5, which provide the 2020 AHA adult,5 pediatric,6 and neonatal guidelines,4 respectively. Recent innovations include using mobile phone technology to summon members of the public who are trained in CPR (see Mobile Phone Technologies to Alert Bystanders of Events Requiring CPR). Although supportive evidence for comprehensive postcardiac arrest interventions remains largely observational (particularly when they are administered together as bundled care at specialized centers) and the results of these studies are mixed, CACs may nonetheless represent a logical clinical link between successful resuscitation and ultimate survival. Lesson 13: Post-Cardiac Arrest Care. Lesson1: system of care. Because there are separate adult and pediatric evidence bases for these questions, the Adult Basic and Advanced Life Support Writing Group and the Pediatric Basic and Advanced Life Support Writing Group performed parallel evaluations of the evidence about early warning scoring systems as well as about rapid response teams (RRTs) and medical emergency teams (METs). These recommendations were created by the AHA Adult Basic and Advanced Life Support Writing Group and are supported by a 2015 systematic evidence review.1,14 A comprehensive ILCOR review is anticipated in 2020. A more comprehensive description of these methods is provided in Part 2: Evidence Evaluation and Guidelines Development.2. Lesson 9: Stroke Part 3.What is the time goal for neurologic assessment by the stroke team or designee and non-contrast CT or MRI performed after hospital arrival? Lesson 11: Tachycardia.A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The American Heart Association is a qualified 501(c)(3) tax-exempt organization. The AHA and other organizations have recommended structures for specific performance-improvement initiatives in resuscitation. Because evidence and guidance are evolving with the COVID-19 situation, this interim guidance is maintained separately from the ECC guidelines. Structure Lesson2: Science of Resuscitation.What is an effect of excessive ventilation? Lesson 12: Cardiac Arrest. 1-800-AHA-USA-1 Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. Extensive information about individual and team training is also provided in Part 6: Resuscitation Education Science.3 Emergency response system development, layperson and dispatcher training in the recognition of cardiac arrest, community CPR training, widespread AED availability, and telecommunicator instructions that enable members of the general public to initiate high-quality CPR and perform early defibrillation are all important components of this step in the out-of-hospital setting. Of 31 studies that assessed the impact of PAD programs, 27 (1 RCT. Low-quality evidence from 13 observational studies37,11,17,19,22,2831 enrolling 95354 patients found improved ROSC in EMS systems with a PAD program compared with systems without a PAD program (OR, 2.45; 95% CI, 1.883.18). The 2020 guidelines are organized into knowledge chunks, grouped into discrete modules of information on specific topics or management issues.3 Each modular knowledge chunk includes a table of recommendations that uses standard AHA nomenclature of COR and LOE. Lesson1: system of care.Which one of the following is an interdependent component of systems of care? A brief introduction or short synopsis is provided to put the recommendations into context with important background information and overarching management or treatment concepts. Lesson6: Airway Management. Early, effective bystander CPR is a critical component of the OHCA Chain of Survival. In a multicenter, international cluster randomized trial, implementation of the bedside pediatric early warning system was associated with a decrease in clinically important deteriorations on the wards of nontertiary care in community hospitals, but not with all-cause mortality. These systems of care guidelines are based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation (ILCOR) and affiliated ILCOR member councils. Table 1. Dallas, TX 75231, Customer Service By definition, the system determines the ultimate outcome and provides collective support and organization. Cardiopulmonary Resuscitation Successful cardiopulmonary resuscitation (CPR) requires the use of it as part of a system of care called the Chain of Survival (Figure 14). Three different types of evidence reviews (systematic reviews, scoping reviews, and evidence updates) were used in the 2020 process. System-wide feedback matters. T/F They consist entirely of diploid cells. As the initial public safety interface with the lay public in a medical emergency, telecommunicators are a critical link in the OHCA Chain of Survival.